Form Name
Third Party Payee Authorization Form
Transaction Authorization Request (Transfer of Value - TOV)
Beneficiary Claim Form
Additional Beneficiary Claim Form
Form W-8BEN, IRS Certificate of Foreign Status of Beneficial Owner
Restricted Beneficiary Payout Form
Deaths Occurring before Dec. 31, 2019
Deaths occurring after Jan. 1, 2020 - Non-qualified account (not IRA)
Deaths occurring after Jan. 1, 2020 - Qualified account (not IRA)
Set up direct deposit to bank account [Electronic Funds Transfer (EFT)]
Set up direct deposit to annuity [Pre-Authorized Payments (PAC)]
Application for Settlement Option Benefit
Request for distribution before age 59½ [Pre-59 1/2 Distribution Request]
Lifetime Income Benefit Rider Reset Form
Lifetime Income Benefit Rider Termination Form
Lifetime Income Benefit Rider Wellbeing Request Form
Nursing Care Verification Form
Terminal Illness Verification
Certification of Trust Agreement
Ownership Change
Form Name
Election of Withholding
IRS Form W-9
Roth Conversion
Form W-8BEN, IRS Certificate of Foreign Status of Beneficial Owner
Arizona - Form A-4P, Request for Arizona Income Tax Withholding
Arkansas - AR4P, Arkansas Tax Withholding Form
Carolina - NC-4P, North Carolina Tax Withholding Form
Connecticut - CT-W4P, Connecticut Tax Withholding Form
Georgia - G4P, Georgia Tax Withholding Form
Michigan - Form MI W-4P, Withholding Certificate for Michigan Annuity Payments
New York - IT-2104-P, New York Tax Withholding Form
Recipient ID#
For your protection, this form may show only the last four digits of your SSN, ITIN, ATIN, or EIN. However, your complete identification number has been reported to the IRS.
Account Number
Your annuity contract number.
Box 1. Total Distribution
Reports the total distribution from the annuity, and may or may not be the taxable amount.
Box 2a. Taxable amount
There could be multiple reasons box 2a is blank. Some of the common scenarios are:
Box 2b.
If 'taxable amount not determined' is checked, we are unable to complete the correct taxable amount based on the data available.
Box 4
Reports federal income tax withheld from your distribution.
Box 7
Provides a distribution code that indicates the nature of the distribution, and will provide information to assist in determining how the distribution needs to be reported on your tax return. A list of distribution codes is provided in the Box 7 paragraph on the reverse side of your 1099-R document.
Box 14-15
Reports any state tax withheld and the taxing jurisdiction for the recipient.
There are various reasons why you might receive this form. Some of the most common examples are:
Participant ID#
For your protection, this form may show only the last four digits of your SSN, ITIN, ATIN, or EIN. However, your complete identification number has been reported to the IRS.
Account Number
Your annuity contract number.
Box 1
Shows traditional IRA contributions made in the reporting tax year and, if designated, through the due date of the tax return not including extensions.
Box 2
Shows any rollover, including a direct rollover to a traditional IRA or Roth IRA. It does not show any amounts you converted from your traditional IRA, SEP IRA, or SIMPLE IRA to a Roth IRA. They are shown in box 3. See the Form 1040 instructions for information on how to report rollovers.
Box 3
Shows the amount converted from a traditional IRA, SEP IRA, or SIMPLE IRA to a Roth IRA for the year.
Box 4
Shows amounts recharacterized from transferring any part of the contribution (plus earnings) from one type of IRA to another.
Box 5
Shows the fair market value of your account at year end.
Box 7
May show the kind of IRA reported on this Form 5498.
Box 8
Shows SEP contributions made during the reporting tax year.
Box 9
Shows SIMPLE contributions made during the reporting tax year.
Box 10
Shows Roth IRA contributions made in the reporting tax year and, if designated, through the due date of the tax return not including extensions.